Classification - Directed Treatment of Low Back Pain

描述(申请人提供)：大多数人会在成年后经历下腰痛(LBP)，超过50%经历过LBP发作的人会复发。尽管与控制这种情况相关的医疗费用很高，但尚未发现任何治疗方法在改善通常持续存在的症状和相关残疾方面始终有效，更重要的是，减少复发。有人提出，缺乏任何一种治疗方法的支持是对不同类型的LBP患者进行研究的结果，需要一种将LBP患者归类为更同质的群体的系统。最近，一种基于运动系统相关损害的腰痛患者分类系统已经被描述和测试。用于对LBP进行分类的损伤与特定的运动方向和排列有关，这些运动和排列与患者在(1)临床检查和(2)功能活动期间的症状一致。这项建议的主要目的是进行一项前瞻性、随机、对照的临床试验，以确定在改善慢性LBP患者的短期和长期结果方面，以个人特定损害为基础的LBP分类指导的治疗是否比非特定物理治疗护理更有效。这项研究的具体目的是在18个月的时间里确定特定分类治疗与非特定治疗对以下方面的影响：(1)包括症状(强度、频率、持续时间、位置和复发)的损害、临床检查测试中的运动和排列障碍，以及标准化临床测试的运动和排列障碍，(2)用OSwestry LBP问卷和Baecke习惯性活动问卷测量的功能限制，以及(3)用SF-36测量的残疾和与LBP相关的活动限制天数。分类治疗将强调(1)改变患者在功能活动中对运动和排列障碍的使用，(2)锻炼以减轻损伤，以及(3)教育，以了解运动和排列的特定方向如何导致症状。非特异性物理治疗将包括全身躯干强化、躯干和四肢柔韧性、身体力学教育和功能活动执行指南。预后因素也将被检查。这项研究的发现对于LBP患者康复所使用的检查和治疗方法的决策具有重要意义，LBP患者通常是一种持续、复发和昂贵的疾病。

DESCRIPTION (provided by applicant): Most people will experience low back pain (LBP) during their adult lives and more than 50% of the people who experience an episode of LBP will have a recurrence. Despite the high health care costs associated with managing this condition, no treatment has been found to be consistently effective in improving the often persistent symptoms and related disability, and more importantly, curtailing the recurrences. It has been suggested that the lack of support of any one treatment is the result of studies being conducted on heterogeneous groups of people with LBP, and a system for classifying people with LBP into more homogeneous groups is needed. Recently, a system of classifying people with LBP based on movement-system related impairments has been described and tested. The impairments used to classify LBP are related to the specific directions of movements and alignments consistently related to the person's symptoms during (1) a clinical examination, and (2) functional activities. The primary purpose of this proposal is to conduct a prospective, randomized, controlled clinical trial to determine if treatment directed by a person's specific impairment- based LBP classification is more effective than non-specific physical therapy care in improving short- and long-term outcomes in people with chronic LBP. The specific aims of this study are to determine the effect of classification- specific treatment versus non-specific treatment across an 18 month period on (1) impairments which include symptoms (intensity, frequency, duration, location, and recurrences), movement and alignment impairments on clinical examination tests, and kinematics of movement and alignment impairments with standardized clinical tests, (2) functional limitations measured with the Oswestry LBP questionnaire and the Baecke Habitual Activity questionnaire, and (3) disability measured with the SF-36 and number of LBP-related activity limitations days. Classification-specific treatment will emphasize (1) changing the person's use of movement and alignment impairments in functional activities, (2) exercise to alleviate impairments, and (3) education to understand how specific directions of movements and alignments contribute to symptoms. The non-specific physical therapy treatment will include general trunk strengthening, trunk and extremity flexibility, and education about body mechanics and guidelines for performance of functional activities. Prognostic factors also will be examined. The findings from this study have important implications with regard to decisions made about examination and treatment methods used in rehabilitation of people with LBP, an often persistent, recurrent and costly condition.